| NPI | 1003064999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD172183) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 15305) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2016-10-03 |