| NPI | 1295027167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 30586) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 9699166-1205) |
| Enumeration Date | 2011-05-10 |
| Last Update Date | 2018-11-11 |