| NPI | 1629077979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 5120535-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11493) |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2021-08-12 |