| NPI | 1518163773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: DE C1-0010255) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD450791) |
| Enumeration Date | 2007-06-25 |
| Last Update Date | 2018-03-17 |