| NPI | 1316467053 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 14255) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-11049) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-05-30 |