| NPI | 1659541449 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD60694621) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 239185) |
| Enumeration Date | 2008-03-07 |
| Last Update Date | 2017-04-07 |