| NPI | 1851309843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 14706) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 21690) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2023-03-07 |