NPI | 1104810761 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D31159) |
Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 12737) |
2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011034) | |
Enumeration Date | 2005-09-09 |
Last Update Date | 2015-06-24 |