| NPI | 1275768111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301094195) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 76896) |
| Enumeration Date | 2009-05-21 |
| Last Update Date | 2022-07-27 |