| NPI | 1770780132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 91491) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 44149) |
| Enumeration Date | 2007-06-29 |
| Last Update Date | 2024-03-13 |