| NPI | 1942651609 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2022-0907) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 286646) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2022-06-29 |