| NPI | 1124224639 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-00603) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD37908) |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2019-06-07 |