| NPI | 1639159577 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 056193) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD421847) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 241788) | |
| Enumeration Date | 2006-01-18 |
| Last Update Date | 2015-12-11 |