| NPI | 1942865985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-53056) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NE 33230) |
| Enumeration Date | 2019-05-06 |
| Last Update Date | 2024-05-01 |