| NPI | 1013179266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21476) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS T-2114) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2017-11-03 |