| NPI | 1942705892 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME166888) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 66096) |
| Enumeration Date | 2018-03-23 |
| Last Update Date | 2024-08-27 |