| NPI | 1700137148 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS16225) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL UO3387) |
| Enumeration Date | 2012-09-25 |
| Last Update Date | 2023-03-30 |