| NPI | 1730138793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS6632) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL OS0006632) |
| 2085B0100X Radiology, Body Imaging (Licence: FL OS6632) | |
| Enumeration Date | 2006-05-08 |
| Last Update Date | 2015-09-28 |