| NPI | 1629045703 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 028638) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MA 28638) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2021-05-24 |