| NPI | 1619407913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102208375) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA 20A22422) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 1859) | |
| Enumeration Date | 2017-06-19 |
| Last Update Date | 2024-08-02 |