| NPI | 1245214675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101246165) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0053956) |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2020-01-27 |