| NPI | 1245499839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME139961) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 57035) |
| Enumeration Date | 2008-06-09 |
| Last Update Date | 2019-07-11 |