| NPI | 1184773004 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0069425) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD437001) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2018-10-27 |