| NPI | 1154367878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2022-1266) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 49550) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2022-09-16 |