| NPI | 1023533767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 76043-23) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 34531) |
| Enumeration Date | 2017-08-03 |
| Last Update Date | 2024-04-23 |