| NPI | 1336151026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 69924) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 34514) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2022-09-05 |