| NPI | 1316359557 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 011056) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 72098) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2024-05-31 |