| NPI | 1952892911 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301511229) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4351027654) |
| 2085B0100X Radiology Body Imaging (Licence: IL 125.081136) | |
| Enumeration Date | 2018-05-25 |
| Last Update Date | 2024-08-16 |