| NPI | 1396768024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: KY 48153) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 015914) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2020-11-17 |