| NPI | 1821438607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2018005762) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD466288) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000058745) | |
| Enumeration Date | 2013-06-26 |
| Last Update Date | 2020-10-29 |