| NPI | 1659891323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A176270) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 276551) |
| Enumeration Date | 2017-06-23 |
| Last Update Date | 2022-08-05 |