| NPI | 1013118702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020011605) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN mo00044498) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2022-09-07 |