| NPI | 1588639025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MO 102182) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KS 0427939) |
| Enumeration Date | 2006-02-20 |
| Last Update Date | 2016-09-13 |