| NPI | 1104899822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 50608) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 42961) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2023-03-14 |