| NPI | 1578726683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-12384) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 104451) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 52314) | |
| Enumeration Date | 2008-07-08 |
| Last Update Date | 2018-01-10 |