| NPI | 1881089456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY TP355) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D89678) |
| Enumeration Date | 2015-04-01 |
| Last Update Date | 2021-08-27 |