| NPI | 1710992276 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 61843) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 2005-0478) |
| Enumeration Date | 2006-07-30 |
| Last Update Date | 2021-04-05 |