| NPI | 1275769028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 54778) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 057032) |
| Enumeration Date | 2009-06-08 |
| Last Update Date | 2022-07-08 |