| NPI | 1376508267 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101057842) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: VA 0101057842) |
| Enumeration Date | 2006-04-20 |
| Last Update Date | 2022-04-15 |