| NPI | 1487660171 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2022-01137) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME70046) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2022-06-03 |