| NPI | 1316947922 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SD 3955) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-33894) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2018-10-02 |