| NPI | 1255837324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101278303) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: VA 0101278303) |
| 2085N0904X (Licence: VA 0101278303) | |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2023-08-07 |