| NPI | 1780661280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 38372) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 47062) |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2021-02-24 |