| NPI | 1639663891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2024-00823) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101281313) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 52709) | |
| Enumeration Date | 2018-06-20 |
| Last Update Date | 2024-07-01 |