| NPI | 1689636185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200500110) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 37728) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2023-02-03 |