| NPI | 1063830628 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 73555) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 61383) |
| Enumeration Date | 2014-04-01 |
| Last Update Date | 2020-10-21 |