| NPI | 1225013261 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD458182) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 220363) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-11-29 |