| NPI | 1386724250 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301081838) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 42892) |
| Enumeration Date | 2006-10-16 |
| Last Update Date | 2015-07-15 |