| NPI | 1821062704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D22299) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101031814) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD33242) | |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2012-12-06 |