| NPI | 1528321452 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101271583) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD463236) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 30267) | |
| Enumeration Date | 2012-06-15 |
| Last Update Date | 2021-06-28 |