| NPI | 1356847834 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 13894379-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 73832-20) |
| Enumeration Date | 2018-04-03 |
| Last Update Date | 2024-07-01 |