| NPI | 1073550612 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M5684) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 208024) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2020-08-14 |