| NPI | 1063892172 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 273743) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 65377) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 54616) | |
| Enumeration Date | 2015-06-03 |
| Last Update Date | 2021-01-06 |