| NPI | 1285171405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2020004310) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA MD61318617) |
| Enumeration Date | 2017-01-25 |
| Last Update Date | 2024-08-30 |