| NPI | 1629266317 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 333468-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 47247-020) |
| Enumeration Date | 2007-10-09 |
| Last Update Date | 2015-10-14 |