| NPI | 1477041390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 52708) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC LL52708) |
| Enumeration Date | 2018-04-26 |
| Last Update Date | 2022-08-30 |