| NPI | 1346245362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 11994) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 07734R) |
| Enumeration Date | 2005-06-16 |
| Last Update Date | 2022-07-01 |