| NPI | 1013356740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 202101879) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 82913) |
| Enumeration Date | 2013-06-15 |
| Last Update Date | 2021-09-02 |