| NPI | 1740786623 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085B0100X Radiology, Body Imaging (Licence: NC 202201452) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2022-01452) |
| Enumeration Date | 2018-04-01 |
| Last Update Date | 2024-03-04 |