| NPI | 1518209766 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 70681) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D80081) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: KY C0501) | |
| Enumeration Date | 2013-03-25 |
| Last Update Date | 2022-02-22 |