| NPI | 1063753291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2017034849) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D83036) |
| Enumeration Date | 2013-03-13 |
| Last Update Date | 2022-08-16 |