| NPI | 1306263660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-46537) |
| Additional Taxonomies | 305S00000X Point of Service |
| Enumeration Date | 2014-03-25 |
| Last Update Date | 2022-04-06 |