| NPI | 1093200966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101278132) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2019018206) |
| Enumeration Date | 2018-06-24 |
| Last Update Date | 2023-07-07 |