| NPI | 1699162818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 42252) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 63017) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101268965) | |
| Enumeration Date | 2015-04-26 |
| Last Update Date | 2023-03-10 |