| NPI | 1003854985 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0055527) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: MD D0055527) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: MD D0055527) | |
| Enumeration Date | 2006-06-03 |
| Last Update Date | 2014-01-23 |