| NPI | 1790219079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX U1639) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0068089) |
| Enumeration Date | 2017-04-13 |
| Last Update Date | 2023-07-10 |