| NPI | 1568429397 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SD 6029) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 34623) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2018-10-17 |