| NPI | 1649245747 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 050198) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 26875) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-07-09 |