| NPI | 1487686713 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 032924) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 70533) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2018-03-17 |