| NPI | 1780079178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0065721) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 13491a) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 33410) | |
| Enumeration Date | 2015-04-02 |
| Last Update Date | 2021-07-22 |