| NPI | 1699904961 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101272946) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q4823) |
| Enumeration Date | 2009-07-08 |
| Last Update Date | 2024-11-07 |