| NPI | 1841658598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60963295) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ZZ 474750) |
| Enumeration Date | 2016-02-09 |
| Last Update Date | 2024-04-25 |