| NPI | 1225370935 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 311561) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AL 33887) |
| Enumeration Date | 2013-03-20 |
| Last Update Date | 2020-03-17 |