| NPI | 1851747422 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301511735) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 90392) |
| Enumeration Date | 2016-05-12 |
| Last Update Date | 2024-09-05 |