| NPI | 1720114002 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD26160) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR MD26160) |
| Enumeration Date | 2007-02-23 |
| Last Update Date | 2022-02-04 |