| NPI | 1598282600 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology Body Imaging (Licence: GA 89498) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: NC 2020-00297) |
| Enumeration Date | 2017-08-29 |
| Last Update Date | 2021-07-07 |