| NPI | 1083751044 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 170694) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D65295) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2011-00108) | |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2022-11-30 |