| NPI | 1134489693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 61598) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA md-45223) |
| Enumeration Date | 2012-05-17 |
| Last Update Date | 2019-07-23 |