| NPI | 1417215732 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101254798) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D84694) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 269366) | |
| Enumeration Date | 2012-04-24 |
| Last Update Date | 2022-06-01 |