| NPI | 1679579502 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102208955) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS007286E) |
| Enumeration Date | 2005-06-24 |
| Last Update Date | 2025-02-17 |