| NPI | 1366698144 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 61995) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NC 180860) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA 125826) | |
| Enumeration Date | 2008-08-13 |
| Last Update Date | 2022-12-07 |