| NPI | 1104111608 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD044237) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD487664C) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0081921) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 71815) | |
| Enumeration Date | 2011-06-13 | 
| Last Update Date | 2025-07-22 |