| NPI | 1558624965 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD453156) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD046227) |
| Enumeration Date | 2012-06-20 |
| Last Update Date | 2023-12-05 |