| NPI | 1790743615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD12276) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 227147) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2019-03-21 |