| NPI | 1205819364 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: FL ME42388) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: NY 144735-1) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: PA MD049357L) | |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: MD D0024612) | |
| Enumeration Date | 2005-11-22 |
| Last Update Date | 2012-10-04 |