| NPI | 1710095096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD07800) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 75574) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2024-05-29 |