| NPI | 1104189349 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301100759) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 67581) |
| Enumeration Date | 2012-06-22 |
| Last Update Date | 2019-09-10 |