| NPI | 1700315264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 71008) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA A176786) |
| Enumeration Date | 2017-06-08 |
| Last Update Date | 2023-10-23 |