| NPI | 1134782428 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 58340) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA r-11391) |
| Enumeration Date | 2019-04-22 |
| Last Update Date | 2023-06-27 |