| NPI | 1790790202 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD15140) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 234438) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-01-31 |