| NPI | 1497247159 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81829-20) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA R-11242) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2023-06-21 |