| NPI | 1336330869 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 43723) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 5126120) |
| Enumeration Date | 2007-08-08 |
| Last Update Date | 2023-01-17 |