| NPI | 1396267787 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101276386) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 290734) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2023-04-19 |