| NPI | 1871191684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 56627) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: TX BP10072981) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10072981) | |
| Enumeration Date | 2020-10-14 |
| Last Update Date | 2022-08-24 |