| NPI | 1649470469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: OR 175201) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N3688) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2016-06-30 |