| NPI | 1518487248 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 89742) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 8290) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2023-06-23 |