| NPI | 1659393247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 039154) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: CT 039154) |
| 2085B0100X Radiology Body Imaging (Licence: CT 039154) | |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2021-06-17 |