| NPI | 1780117101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 23567) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 64241) |
| Enumeration Date | 2017-04-04 |
| Last Update Date | 2024-06-05 |