| NPI | 1770573388 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D40414) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0008339) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD17472) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101045431) | |
| Enumeration Date | 2005-10-25 |
| Last Update Date | 2018-03-30 |