| NPI | 1952462426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101233165) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD057925L) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD33074) | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2007-07-08 |