| NPI | 1609836071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD15758) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD39439) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NM TM2004-0831) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 39159) | |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2013-03-26 |