| NPI | 1174612337 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL TRN9101) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 24399) |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2022-01-28 |