| NPI | 1992202303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 73335) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 73479) |
| Enumeration Date | 2018-04-11 |
| Last Update Date | 2023-10-27 |