| NPI | 1891142824 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD61176528) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: KY R4918) |
| Enumeration Date | 2016-05-19 |
| Last Update Date | 2022-05-03 |