| NPI | 1548218464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 15146) |
| Additional Taxonomies | 2085B0100X Radiology Body Imaging (Licence: AZ 24628) |
| Enumeration Date | 2006-05-04 |
| Last Update Date | 2014-08-27 |