| NPI | 1659628154 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0102205709) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA 15425) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2022-01-25 |