| NPI | 1225219421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 4955199-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 19409) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042.0014235) | |
| Enumeration Date | 2007-11-16 |
| Last Update Date | 2019-04-16 |