| NPI | 1093714123 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200101598) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 21638) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2017-12-20 |