| NPI | 1912403015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD483930) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 58834) |
| Enumeration Date | 2018-04-05 |
| Last Update Date | 2024-07-18 |