| NPI | 1427008549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 32593) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 79973) |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2020-10-22 |