| NPI | 1295099927 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101019886) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 056166) |
| Enumeration Date | 2012-06-27 |
| Last Update Date | 2018-07-31 |