| NPI | 1952740722 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101266500) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D79758) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2021-09-16 |