| NPI | 1720042674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 5101005903) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI JK005903) |
| Enumeration Date | 2006-04-15 |
| Last Update Date | 2011-08-23 |