| NPI | 1972090363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 81389) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 27426) |
| Enumeration Date | 2018-04-20 |
| Last Update Date | 2023-06-05 |