| NPI | 1669451639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 48653) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 52025) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2024-01-09 |