| NPI | 1053395871 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD16170) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0031986) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA O101225373) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2013-06-17 |