| NPI | 1255763579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 20357) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA R-10209) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-45122) | |
| Enumeration Date | 2013-08-09 |
| Last Update Date | 2021-05-03 |