| NPI | 1003309766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 52560) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 04-46948) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13237185-1205) | |
| Enumeration Date | 2018-06-07 |
| Last Update Date | 2024-08-01 |