| NPI | 1619952603 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 028865) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 246166) |
| Enumeration Date | 2005-12-13 |
| Last Update Date | 2018-03-17 |