| NPI | 1619965514 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME93747) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 57149) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2022-12-22 |