| NPI | 1972064764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR PG208759) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR FE191849) |
| Enumeration Date | 2019-03-26 |
| Last Update Date | 2022-09-13 |