| NPI | 1750643110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA MD-45191) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301111718) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IL 125-061332) | |
| Enumeration Date | 2012-06-12 |
| Last Update Date | 2018-06-27 |