| NPI | 1477085520 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2022019192) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 40628) |
| Enumeration Date | 2017-03-29 |
| Last Update Date | 2024-02-21 |