| NPI | 1558503102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 53470) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 38656) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52431) | |
| 2085U0001X Radiology, Diagnostic Ultrasound (Licence: PA MT183566) | |
| Enumeration Date | 2009-03-28 |
| Last Update Date | 2018-04-12 |