| NPI | 1447524079 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX P6112) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63630) |
| Enumeration Date | 2012-02-29 |
| Last Update Date | 2019-06-26 |