| NPI | 1578829503 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD464052) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 66872-20) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2020-10-05 |