| NPI | 1174889182 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0013673) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P7125) |
| Enumeration Date | 2012-04-03 |
| Last Update Date | 2018-10-31 |