| NPI | 1457586562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q2534) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 62003) |
| Enumeration Date | 2009-05-18 |
| Last Update Date | 2024-07-19 |