| NPI | 1578591616 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX D5925) |
| Additional Taxonomies | 2085N0700X (Licence: PA MD068981) |
| 2085N0700X (Licence: PA MD068981L) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD068981L) | |
| Enumeration Date | 2006-06-29 |
| Last Update Date | 2017-04-14 |