| NPI | 1164439873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2013-01741) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27062) |
| Enumeration Date | 2006-08-02 |
| Last Update Date | 2019-07-10 |