| NPI | 1588899215 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101020825) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN DO3028) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT013155) | |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2022-03-31 |