| NPI | 1568769099 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66290) |
| Additional Taxonomies | 2085N0700X (Licence: WI 66290-20) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66290-20) | |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2024-12-05 |