| NPI | 1346476066 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63735-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301500785) |
| 2085B0100X Radiology, Body Imaging (Licence: WI 63735) | |
| Enumeration Date | 2009-06-09 |
| Last Update Date | 2023-02-06 |