| NPI | 1588043798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 13372) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 72445) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY TL7180) | |
| Enumeration Date | 2015-05-20 |
| Last Update Date | 2022-05-04 |