| NPI | 1225002702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 40653) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 47107) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2016-08-08 |