| NPI | 1508091893 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: MO 2022047337) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD453837) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2022047337) | |
| Enumeration Date | 2009-05-15 |
| Last Update Date | 2023-01-09 |