| NPI | 1396784658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 11760) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND PT21574) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2024-10-07 |