| NPI | 1326025057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 059314) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 66469) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54635) | |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2021-01-06 |