| NPI | 1124033055 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 16799) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 022779) |
| Enumeration Date | 2006-07-29 |
| Last Update Date | 2023-11-08 |