| NPI | 1083945851 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101262099) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0087426) |
| Enumeration Date | 2010-01-19 |
| Last Update Date | 2022-07-21 |