| NPI | 1568662252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 12305) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA R8130) |
| Enumeration Date | 2007-07-20 |
| Last Update Date | 2020-08-18 |