| NPI | 1932199940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 6740) |
| Additional Taxonomies | 2085N0700X (Licence: WI 35203) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2022-11-17 |