| NPI | 1477863116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 26284) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 41044) |
| Enumeration Date | 2010-10-15 |
| Last Update Date | 2014-11-07 |