| NPI | 1144664145 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR 191861) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2018011304) |
| Enumeration Date | 2013-04-20 |
| Last Update Date | 2019-06-05 |