| NPI | 1407855844 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA C143106) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA C143106) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD435571) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2018-03-17 |