| NPI | 1811158256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD218008) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 104519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52240) | |
| Enumeration Date | 2008-06-18 |
| Last Update Date | 2024-01-18 |