| NPI | 1518048636 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 51547) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY C0608) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2022-03-10 |