| NPI | 1063438299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101280416) |
| Additional Taxonomies | 2085N0700X (Licence: VA 0101280416) |
| 2085N0700X (Licence: IA MD43047) | |
| 2085N0700X (Licence: MO 105361) | |
| Enumeration Date | 2006-07-14 |
| Last Update Date | 2024-01-05 |