| NPI | 1184087975 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 36487) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 65824) |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2023-08-09 |