| NPI | 1649911454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MTL500002066) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4351049530) |
| Enumeration Date | 2022-04-05 |
| Last Update Date | 2023-06-15 |