| NPI | 1194721027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 013941) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: CT 013941) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2022-09-12 |