| NPI | 1154306553 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101239400) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0087597) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2020-01-27 |