| NPI | 1063538544 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 16433) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: MI 4301100083) |
| Enumeration Date | 2007-03-22 |
| Last Update Date | 2017-10-20 |