| NPI | 1306295431 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 39564) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MTL004342) |
| Enumeration Date | 2016-06-09 |
| Last Update Date | 2022-07-25 |