| NPI | 1609213453 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 10883) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 107010) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 56828) | |
| Enumeration Date | 2013-06-03 |
| Last Update Date | 2018-08-23 |