| NPI | 1013100312 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301090698) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 56973) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2018-11-29 |