| NPI | 1235549270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D85195) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 6472-851) |
| Enumeration Date | 2014-04-29 |
| Last Update Date | 2021-07-26 |