| NPI | 1336597582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 04-44773) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A200156) |
| Enumeration Date | 2016-05-27 |
| Last Update Date | 2025-05-26 |