| NPI | 1205937547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M9906) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TX M9906) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006013767) | |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2023-08-11 |