| NPI | 1063650190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249296) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0072253) |
| Enumeration Date | 2009-01-27 |
| Last Update Date | 2020-01-27 |