| NPI | 1386105989 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 75736) |
| Additional Taxonomies | 2085N0904X (Licence: WI 75736) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2024-05-15 |