| NPI | 1063436202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0029335) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101045105) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD11898) | |
| Enumeration Date | 2006-07-27 |
| Last Update Date | 2007-07-08 |