| NPI | 1558749283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101272533) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A167770) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0092289) | |
| Enumeration Date | 2015-05-14 |
| Last Update Date | 2022-02-04 |