| NPI | 1710938311 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 19199) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 36455) |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2023-03-07 |