| NPI | 1346534120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX Q4923) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX BP20040440) |
| Enumeration Date | 2011-06-08 |
| Last Update Date | 2016-07-26 |