| NPI | 1871836312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101266407) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0087858) |
| Enumeration Date | 2013-04-03 |
| Last Update Date | 2022-02-04 |