| NPI | 1508860883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 13310) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 29805) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 29805) | |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2023-11-30 |