| NPI | 1043567530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 55510) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 62101) |
| Enumeration Date | 2012-08-14 |
| Last Update Date | 2020-09-11 |