| NPI | 1669829875 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD472957) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D85401) |
| Enumeration Date | 2016-05-17 |
| Last Update Date | 2022-06-30 |