| NPI | 1003002783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD432844) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 053750) |
| Enumeration Date | 2007-09-17 |
| Last Update Date | 2020-10-05 |