| NPI | 1871939264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 83720) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101020221) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-00204) | |
| Enumeration Date | 2013-05-13 |
| Last Update Date | 2021-11-02 |