| NPI | 1255794897 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 75429) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: WI 75429-21) |
| Enumeration Date | 2016-03-31 |
| Last Update Date | 2022-09-07 |