| NPI | 1104868850 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2005-0536) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 12285899-1205) |
| Enumeration Date | 2006-06-10 |
| Last Update Date | 2021-06-10 |