| NPI | 1316920267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 14556) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 55147) |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2021-06-09 |