| NPI | 1720436900 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD203467) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX 651443) |
| Enumeration Date | 2016-05-29 |
| Last Update Date | 2021-06-22 |