| NPI | 1043659238 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020011606) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 007942) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A17731) | |
| Enumeration Date | 2013-06-20 |
| Last Update Date | 2020-06-12 |