NPI | 1215463583 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61678180) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101275972) |
Enumeration Date | 2017-05-05 |
Last Update Date | 2025-07-01 |