| NPI | 1275064651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01665) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 26376) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR e-13755) | |
| Enumeration Date | 2017-03-27 |
| Last Update Date | 2022-09-08 |