| NPI | 1588078513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 16583) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-46147) |
| Enumeration Date | 2014-06-18 |
| Last Update Date | 2020-08-14 |