| NPI | 1316247828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 046728) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 250101) |
| Enumeration Date | 2010-10-31 |
| Last Update Date | 2018-01-15 |