| NPI | 1235369901 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD439014) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 62441) |
| Enumeration Date | 2009-07-16 |
| Last Update Date | 2019-08-05 |