| NPI | 1154762078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63972-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 192192) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2024-08-09 |