| NPI | 1003998717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-47735) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: IA MD-47735) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 36426) | |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2020-11-19 |