| NPI | 1629014717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 13524) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 21241) |
| Enumeration Date | 2006-06-20 |
| Last Update Date | 2023-03-07 |