| NPI | 1548436025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD12965) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301091796) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 257779) | |
| Enumeration Date | 2008-05-05 |
| Last Update Date | 2024-03-15 |