| NPI | 1043653512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-13085) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 34890) |
| Enumeration Date | 2013-04-15 |
| Last Update Date | 2020-07-09 |