| NPI | 1700171329 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 33729) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 302884) |
| Enumeration Date | 2011-06-10 |
| Last Update Date | 2021-03-24 |