| NPI | 1073562088 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0041613) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD044122E) |
| 174400000X Specialist (Licence: MD D0041613) | |
| 174400000X Specialist (Licence: NY 205142) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2021-10-15 |