| NPI | 1043475247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 40113) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA R8296) |
| Enumeration Date | 2008-07-28 |
| Last Update Date | 2015-12-21 |