| NPI | 1023058310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX H9980) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: HI 9728) |
| Enumeration Date | 2006-06-07 |
| Last Update Date | 2016-05-02 |