| NPI | 1417061482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 6408A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD216371) |
| Enumeration Date | 2006-08-18 |
| Last Update Date | 2023-06-27 |