| NPI | 1114974672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301076268) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 227964) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2019-09-06 |