| NPI | 1114247889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 56180) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 262368) |
| Enumeration Date | 2010-06-04 |
| Last Update Date | 2018-03-17 |