| NPI | 1902008709 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX m6839) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI EMC0002265) |
| Enumeration Date | 2007-06-04 |
| Last Update Date | 2024-03-12 |