| NPI | 1407841042 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 036164) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CT 36164) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2023-09-07 |