| NPI | 1528248960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MS 22614) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 2012011801) |
| Enumeration Date | 2007-11-13 |
| Last Update Date | 2017-11-03 |