| NPI | 1609998541 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2018-01976) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 239801) |
| Enumeration Date | 2007-04-04 |
| Last Update Date | 2018-07-30 |