| NPI | 1639517469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 63933) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR 192524) |
| Enumeration Date | 2013-06-14 |
| Last Update Date | 2019-06-25 |