| NPI | 1699752709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 11712) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 48044) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-01-03 |