| NPI | 1396186367 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 303115) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101264403) |
| Enumeration Date | 2013-07-08 |
| Last Update Date | 2021-08-02 |