| NPI | 1710473954 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD210001657) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WA FE60856977) |
| Enumeration Date | 2018-07-10 |
| Last Update Date | 2022-07-16 |