| NPI | 1588014617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2021014289) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T5626) |
| Enumeration Date | 2016-06-20 |
| Last Update Date | 2022-04-05 |