| NPI | 1932595923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD469950) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP10054934) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 289620) | |
| Enumeration Date | 2015-04-07 |
| Last Update Date | 2024-11-14 |