| NPI | 1578626529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 16668) |
| Additional Taxonomies | 207V00000X Obstetrics & Gynecology (Licence: WV 16668) |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: WV 16668) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2018-01-17 |