| NPI | 1588839252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 246530) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MA 246530) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD18576) | |
| Enumeration Date | 2008-04-24 |
| Last Update Date | 2022-06-29 |