| NPI | 1336375500 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 078017) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA 60079309) |
| Enumeration Date | 2009-06-02 |
| Last Update Date | 2024-02-21 |