| NPI | 1598939613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 79292) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-11266) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD153978) | |
| Enumeration Date | 2008-04-18 |
| Last Update Date | 2011-10-14 |