| NPI | 1548268378 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2000-00497) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 22012) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2017-12-20 |