| NPI | 1558352138 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2013-0672) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD 019240) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2014-03-13 |