| NPI | 1720379720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 32065) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24796) |
| Enumeration Date | 2011-04-25 |
| Last Update Date | 2022-07-21 |