| NPI | 1578500161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD056193L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 81530) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2025-01-02 |