| NPI | 1669636197 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2016-00375) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MT193582) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101253378) | |
| Enumeration Date | 2008-07-14 |
| Last Update Date | 2023-03-10 |