| NPI | 1750339594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 59584) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME77317) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2024-11-15 |