| NPI | 1013356781 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SD 11490) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 107741) |
| Enumeration Date | 2013-06-17 |
| Last Update Date | 2019-10-07 |