| NPI | 1831623545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101275069) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX S0018) |
| Enumeration Date | 2017-04-19 |
| Last Update Date | 2022-07-08 |