| NPI | 1528052594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 26598) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 24159) |
| Enumeration Date | 2005-09-07 |
| Last Update Date | 2016-07-06 |