| NPI | 1518952068 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 31091) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 37721) |
| Enumeration Date | 2005-09-12 |
| Last Update Date | 2017-12-20 |