| NPI | 1578553509 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI MD06642) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 76568) |
| Enumeration Date | 2005-10-21 |
| Last Update Date | 2019-03-26 |