| NPI | 1376651547 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 200200640) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101038248) |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2016-09-08 |