| NPI | 1205298411 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 54948) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ R75554) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 75428-20) | |
| Enumeration Date | 2016-03-26 |
| Last Update Date | 2022-07-22 |