| NPI | 1417968579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2001-00961) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D73182) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD429060) | |
| Enumeration Date | 2006-08-11 |
| Last Update Date | 2016-06-27 |