| NPI | 1689086878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2020-00115) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D81231) |
| Enumeration Date | 2014-05-22 |
| Last Update Date | 2020-01-23 |