| NPI | 1093174617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 21358) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 30492) |
| Enumeration Date | 2016-02-11 |
| Last Update Date | 2023-08-09 |