| NPI | 1578514287 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 50011) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 36559) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2024-02-26 |