| NPI | 1255508644 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 23872) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD448253) |
| Enumeration Date | 2008-05-14 |
| Last Update Date | 2021-06-10 |