| NPI | 1578568903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX L0130) |
| Additional Taxonomies | 174400000X Specialist (Licence: TX L0130) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2024-03-01 |