| NPI | 1548752231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2023-00651) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP10065928) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2023-06-13 |