| NPI | 1649311754 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101057626) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D55017) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD19964) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2022-01-18 |