| NPI | 1912496670 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 73114) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 11371804-1205) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MA 3015620) | |
| Enumeration Date | 2018-05-08 |
| Last Update Date | 2024-07-05 |