| NPI | 1851348247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301061744) |
| Additional Taxonomies | 2085N0904X (Licence: VA 0101032700) |
| 2085N0904X (Licence: MD D0026059) | |
| 2085N0904X (Licence: MI 4301061744) | |
| 2085N0904X (Licence: DC MD11451) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0026059) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101032700) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD11451) | |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2013-02-06 |