| NPI | 1679917801 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271879) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 60357) |
| Enumeration Date | 2013-04-18 |
| Last Update Date | 2022-02-04 |