| NPI | 1184626574 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME95745) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 53265) |
| Enumeration Date | 2005-08-15 |
| Last Update Date | 2023-11-02 |