| NPI | 1972982569 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AL MD.37222) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TN 61214) |
| Enumeration Date | 2015-05-28 |
| Last Update Date | 2021-06-21 |