| NPI | 1043763758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 280897) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 266786) |
| Enumeration Date | 2016-07-28 |
| Last Update Date | 2019-11-27 |