| NPI | 1811287634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2013-0597) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AS 2224-C) |
| Enumeration Date | 2011-04-13 |
| Last Update Date | 2016-07-06 |