| NPI | 1720411283 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 284058) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-00798) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 264122) | |
| Enumeration Date | 2013-08-19 |
| Last Update Date | 2021-04-22 |