| NPI | 1942272562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WV 12183) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD033301E) |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2022-12-02 |