| NPI | 1942297767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D64640) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 157522) |
| Enumeration Date | 2005-10-06 |
| Last Update Date | 2021-04-08 |