| NPI | 1225001407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-00038) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 36695) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD050109L) | |
| Enumeration Date | 2006-02-09 |
| Last Update Date | 2017-12-20 |