| NPI | 1255538096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 8042A) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IN 01063733A) |
| Enumeration Date | 2007-06-27 |
| Last Update Date | 2016-09-29 |