| NPI | 1710364187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: WI 74551) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA ML60655403) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 74551) | |
| Enumeration Date | 2015-05-05 |
| Last Update Date | 2021-08-04 |