| NPI | 1710961545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD21650) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0048073) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA O101052672) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00031501) | |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2013-06-17 |