| NPI | 1538463724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101251648) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD037929) |
| Enumeration Date | 2011-01-02 |
| Last Update Date | 2012-10-11 |