| NPI | 1245525112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 29030) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 6499) |
| Enumeration Date | 2011-06-18 |
| Last Update Date | 2017-05-08 |