| NPI | 1750485108 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4077) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0064020) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 230588) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2015-11-09 |