| NPI | 1881191617 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX T3689) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2023002791) |
| Enumeration Date | 2018-04-09 |
| Last Update Date | 2024-12-29 |