| NPI | 1992789127 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR33623) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: DC MD31271) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D0039977) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA O101045126) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00043888) | |
| Enumeration Date | 2005-12-01 |
| Last Update Date | 2013-10-02 |