| NPI | 1851334874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4100) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: PR 16353) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PR 16353) | |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2022-07-21 |