| NPI | 1194791764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 167635) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 208245) |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2014-09-15 |