| NPI | 1659783652 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 87580) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 69866) |
| Enumeration Date | 2014-05-24 |
| Last Update Date | 2022-05-18 |