| NPI | 1538165774 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 35082) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 13962) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2017-12-20 |