| NPI | 1265738496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 047418) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 249459) |
| Enumeration Date | 2011-02-05 |
| Last Update Date | 2018-03-17 |