| NPI | 1821452947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2022-0899) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-14301) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2022040061) | |
| Enumeration Date | 2016-04-06 |
| Last Update Date | 2023-07-18 |