| NPI | 1508988775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD210001732) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 07833) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.06001R) | |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2023-06-30 |