| NPI | 1235423187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101252666) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 81764) |
| Enumeration Date | 2011-06-07 |
| Last Update Date | 2022-07-01 |