| NPI | 1245657436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101274444) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 281781) |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-06-27 |