| NPI | 1669899530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 64820) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 5385-851) |
| Enumeration Date | 2014-03-27 |
| Last Update Date | 2021-04-02 |