| NPI | 1134582976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX U4767) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD210002309) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D94376) | |
| Enumeration Date | 2016-03-30 |
| Last Update Date | 2023-07-26 |