| NPI | 1780191684 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD20743) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 1022315) |
| Enumeration Date | 2018-01-02 |
| Last Update Date | 2026-01-19 |