| NPI | 1730574591 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61158049) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL TRN23059) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME151547) | |
| Enumeration Date | 2015-03-30 |
| Last Update Date | 2021-07-20 |