| NPI | 1639272164 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 35243) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 25706) |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2023-01-06 |