| NPI | 1821062399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 39084) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27495) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TN MD0000026365) | |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2018-03-27 |