| NPI | 1891763124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 5842) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 12628) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD436002) | |
| Enumeration Date | 2006-03-11 |
| Last Update Date | 2016-06-27 |