| NPI | 1952391567 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD09750) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 151472) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: RI 9750) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2023-11-08 |