| NPI | 1023346483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS017625) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI L1593670) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NY 279942) | |
| Enumeration Date | 2009-11-24 |
| Last Update Date | 2016-12-01 |