| NPI | 1770705329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 23291) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 8101525-1205) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2024-04-08 |