| NPI | 1942599667 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D82765) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 58251) |
| Enumeration Date | 2011-04-04 |
| Last Update Date | 2018-12-20 |