| NPI | 1598851396 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR D024734) |
| Additional Taxonomies | 174400000X Specialist (Licence: OR DO24734) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 066693) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2016-01-13 |