| NPI | 1679528467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: TX M5724) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 057464) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2017-05-03 |