| NPI | 1366497943 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 36829) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23046) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2021-04-01 |