| NPI | 1831192087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D69743) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 15756) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2022-03-25 |