| NPI | 1710986229 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200001227) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22037) |
| Enumeration Date | 2005-07-18 |
| Last Update Date | 2017-12-20 |