| NPI | 1154381432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101275102) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 42094) |
| Enumeration Date | 2006-03-23 |
| Last Update Date | 2022-07-08 |