| NPI | 1699836601 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2023-1496) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 10039) |
| Enumeration Date | 2006-12-13 |
| Last Update Date | 2023-12-27 |