| NPI | 1982091427 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60978349) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 71128) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 128378) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2023-10-13 |