| NPI | 1962852798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D91019) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301110445) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4351043525) | |
| Enumeration Date | 2016-06-13 |
| Last Update Date | 2022-06-02 |