| NPI | 1306854500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 28282) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GU MC-204) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2024-06-13 |