| NPI | 1306209770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085N0700X (Licence: CO DR.0070198) |
| Additional Taxonomies | 2085N0700X (Licence: UT 12220353-1205) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 12220353-1205) | |
| Enumeration Date | 2016-04-01 |
| Last Update Date | 2023-07-31 |