| NPI | 1790771350 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0044761) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD20283) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2025-03-27 |