| NPI | 1376928978 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0065934) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY R3852) |
| Enumeration Date | 2015-07-23 |
| Last Update Date | 2021-11-02 |