| NPI | 1407201916 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2022-00233) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A153366) |
| Enumeration Date | 2016-05-03 |
| Last Update Date | 2022-09-02 |