| NPI | 1487015384 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 277329) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 68186) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY 55581) | |
| Enumeration Date | 2016-03-19 |
| Last Update Date | 2024-09-10 |