| NPI | 1770901134 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2020011268) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 11166865-1205) |
| Enumeration Date | 2014-04-02 |
| Last Update Date | 2020-07-13 |