| NPI | 1558780940 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 66556) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2017043788) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 322598) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-08-15 |