| NPI | 1891759817 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0203X Radiology, Therapeutic Radiology (Licence: MD D0063803) |
| Additional Taxonomies | 2085R0203X Radiology, Therapeutic Radiology (Licence: VA 0101046018) |
| Enumeration Date | 2006-04-14 |
| Last Update Date | 2012-04-18 |