| NPI | 1679852271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2016-0110) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2011019836) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0056443) | |
| Enumeration Date | 2011-08-12 |
| Last Update Date | 2016-06-24 |