| NPI | 1700856192 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 33144) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CA 110426) |
| 2085B0100X Radiology, Body Imaging (Licence: VA 101233161) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2015-11-03 |