| NPI | 1336359132 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M6486) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 203681) |
| Enumeration Date | 2007-05-23 |
| Last Update Date | 2016-09-30 |