| NPI | 1083888390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2014-0628) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 7469971-1205) |
| Enumeration Date | 2008-04-17 |
| Last Update Date | 2017-03-22 |