| NPI | 1336593300 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 73288) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2021017409) |
| Enumeration Date | 2016-04-15 |
| Last Update Date | 2023-07-31 |