| NPI | 1912290883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 047049) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD442922) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 250372) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA Pending) | |
| Enumeration Date | 2011-05-25 |
| Last Update Date | 2018-01-15 |