| NPI | 1639523756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 87058) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: GA 87058) |
| 2085B0100X Radiology, Body Imaging (Licence: MO 2020026326) | |
| Enumeration Date | 2016-04-14 |
| Last Update Date | 2024-10-21 |