| NPI | 1376992123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01744) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 290791) |
| Enumeration Date | 2016-06-11 |
| Last Update Date | 2022-06-22 |