| NPI | 1073799763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200401274) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 34335) |
| Enumeration Date | 2008-01-14 |
| Last Update Date | 2017-12-20 |