| NPI | 1053379800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD d61489) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD428683) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD043271) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 010237987) | |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2023-03-30 |