| NPI | 1366709842 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63837) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA L-248554) |
| Enumeration Date | 2012-04-20 |
| Last Update Date | 2015-07-13 |