| NPI | 1003892340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 022364) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 246163) |
| Enumeration Date | 2005-12-19 |
| Last Update Date | 2018-01-15 |