| NPI | 1528056496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD10244) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 212505) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: RI 10244) | |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-03-19 |