| NPI | 1104210673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0070427) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD474252) |
| Enumeration Date | 2015-03-23 |
| Last Update Date | 2024-06-24 |