| NPI | 1871768457 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 55085) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 135225) |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2025-02-13 |