| NPI | 1417916883 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9300284) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 29605) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2020-09-15 |