| NPI | 1124111398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD065337L) |
| Additional Taxonomies | 2085N0904X (Licence: PA MD065337L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C53626) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2015-07-29 |