| NPI | 1407824972 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NM MD2006-0138) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 21526) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-53638) | |
| Enumeration Date | 2006-03-10 |
| Last Update Date | 2025-05-01 |