| NPI | 1962499277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D22885) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 220641) |
| Enumeration Date | 2005-10-03 |
| Last Update Date | 2013-02-04 |