| NPI | 1235196155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 15030) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 53540) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2015-06-11 |