| NPI | 1821417296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME158992) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A168732) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 312394) | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2022-11-15 |