| NPI | 1588603252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 158648) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GU M-2213) |
| Enumeration Date | 2006-06-06 |
| Last Update Date | 2021-04-09 |