| NPI | 1457713166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 291494) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 75218) |
| Enumeration Date | 2016-03-22 |
| Last Update Date | 2022-07-11 |