| NPI | 1164654158 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0080080) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 62645) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD456334) | |
| Enumeration Date | 2009-08-10 |
| Last Update Date | 2018-06-18 |