| NPI | 1376523589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 74245) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 41470) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2025-01-10 |