| NPI | 1124002654 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47802) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD20361) |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2024-12-24 |