| NPI | 1578602504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2012-0597) |
| Additional Taxonomies | 208D00000X General Practice (Licence: NM 2006-0380) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249264) | |
| Enumeration Date | 2007-02-06 |
| Last Update Date | 2016-07-19 |