| NPI | 1083970602 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 69352) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-04992) |
| Enumeration Date | 2012-04-09 |
| Last Update Date | 2018-07-05 |