| NPI | 1700822244 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA OP60787544) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO R4F61) |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2022-09-28 |