| NPI | 1124099551 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47125) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 45331) |
| Enumeration Date | 2006-02-01 |
| Last Update Date | 2020-09-14 |