| NPI | 1245206887 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0100935) |
| Additional Taxonomies | 174400000X Specialist (Licence: PA MD425563) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239455) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2024-08-23 |