| NPI | 1659606325 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD441788) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24039) |
| Enumeration Date | 2009-10-13 |
| Last Update Date | 2019-02-27 |