| NPI | 1831269018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM MD2006-0702) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 32308) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2006002442) | |
| Enumeration Date | 2006-11-08 |
| Last Update Date | 2007-07-19 |