| NPI | 1568697142 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 27024) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA MD-41675) |
| Enumeration Date | 2009-05-26 |
| Last Update Date | 2016-05-23 |