| NPI | 1124072467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A54959) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 75750) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2025-04-07 |