| NPI | 1700382694 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 25890) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 95624) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-08-02 |