| NPI | 1063704534 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-11408) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 65163) |
| Enumeration Date | 2011-05-03 |
| Last Update Date | 2021-02-09 |