| NPI | 1720064249 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 031766) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 246200) |
| Enumeration Date | 2005-12-16 |
| Last Update Date | 2018-01-15 |