| NPI | 1558710392 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D93298) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 267431) |
| Enumeration Date | 2016-06-10 |
| Last Update Date | 2022-06-23 |