| NPI | 1073907556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 5927519-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 5927519-8905) |
| Enumeration Date | 2015-03-24 |
| Last Update Date | 2022-06-26 |