| NPI | 1508854472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: RI MD11408) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 217024) |
| Enumeration Date | 2005-10-13 |
| Last Update Date | 2019-04-02 |