| NPI | 1184800633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 66657) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 002729) |
| Enumeration Date | 2008-01-15 |
| Last Update Date | 2022-01-07 |