| NPI | 1376039669 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 74262) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA MD-49050) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA R-11145) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-49050) | |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2023-10-05 |