| NPI | 1154355212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 038376) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 070573) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-03-17 |