| NPI | 1619936424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301065847) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2001-305) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2023-06-26 |