| NPI | 1972648400 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0027981) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD9977) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101039668) | |
| Enumeration Date | 2007-02-21 |
| Last Update Date | 2011-11-22 |