| NPI | 1851380653 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD08159) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 154853) |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2024-03-15 |