| NPI | 1679518492 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: SC 30477) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 49222) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 30477) | |
| Enumeration Date | 2006-06-17 |
| Last Update Date | 2021-05-17 |