| NPI | 1447335039 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA OS006032E) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NJ MB0628300000) |
| Enumeration Date | 2006-10-25 |
| Last Update Date | 2023-12-11 |