| NPI | 1104040708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301089479) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 55943) |
| 2085B0100X Radiology, Body Imaging (Licence: WI 55943) | |
| Enumeration Date | 2007-04-13 |
| Last Update Date | 2023-05-31 |