| NPI | 1013337351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101269520) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R3479) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD192591) | |
| Enumeration Date | 2014-04-25 |
| Last Update Date | 2023-09-07 |