| NPI | 1801869789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0102201445) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO195635) |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2020-01-14 |