| NPI | 1740284009 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD071371L) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D69227) |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2022-04-28 |