| NPI | 1689602872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101045363) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 30992) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2024-02-20 |