| NPI | 1851606420 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2016-00101) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 265484) |
| Enumeration Date | 2010-08-08 |
| Last Update Date | 2022-07-21 |