| NPI | 1063455095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101245137) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD 897862) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2019-08-16 |