| NPI | 1386164671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 45821) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 67562) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2021-01340) | |
| Enumeration Date | 2017-06-27 |
| Last Update Date | 2023-08-09 |