| NPI | 1720065931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: CA G52182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 031741) |
| Enumeration Date | 2005-12-29 |
| Last Update Date | 2022-08-11 |