| NPI | 1427272756 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60655610) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 222126) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2016-09-28 |