| NPI | 1629077789 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD6699) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0014031) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101022473) | |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2007-11-01 |