| NPI | 1518902709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 34036) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 21739) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2023-03-07 |