| NPI | 1679005052 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 83486) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351045605) |
| Enumeration Date | 2017-04-03 |
| Last Update Date | 2024-06-20 |