| NPI | 1932548567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD467077) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT205605) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2021-10-05 |