| NPI | 1710982947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2018-0036) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 48125) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 36876) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 49207) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2018-09-13 |