| NPI | 1477999274 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2019-00675) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 82189) |
| Enumeration Date | 2013-05-20 |
| Last Update Date | 2019-10-15 |