| NPI | 1376770008 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD14876) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 14876) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 257907) | |
| Enumeration Date | 2009-06-20 |
| Last Update Date | 2019-03-15 |