| NPI | 1457686156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 061806) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 228310) |
| Enumeration Date | 2009-10-14 |
| Last Update Date | 2022-09-26 |