| NPI | 1609886449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M9416) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 10021) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2018-01-10 |