| NPI | 1396770111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 041324) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 214123) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2018-03-17 |