| NPI | 1225279136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA DO-04692) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 258603) |
| Enumeration Date | 2009-03-23 |
| Last Update Date | 2015-04-02 |