| NPI | 1902829260 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101261157) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 222637) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 276297) | |
| Enumeration Date | 2006-07-26 |
| Last Update Date | 2019-06-19 |