| NPI | 1689836124 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 28443) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 43340) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2016-07-25 |