| NPI | 1164460358 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60320843) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI EMC0001580) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2025-01-28 |