| NPI | 1528632122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL MFC1840) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 1840) |
| Enumeration Date | 2021-05-18 |
| Last Update Date | 2021-06-02 |