| NPI | 1497977268 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 49778) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 247040) |
| Enumeration Date | 2007-05-02 |
| Last Update Date | 2018-01-17 |