| NPI | 1861481376 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0061925) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 226992) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2020-01-29 |