| NPI | 1699903930 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 13566) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 59265) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2019-03-01 |