| NPI | 1669471587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD18771) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0040988) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101027010) | |
| Enumeration Date | 2005-07-21 |
| Last Update Date | 2007-11-01 |