| NPI | 1730312521 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD454666) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 19506) |
| Enumeration Date | 2009-08-27 |
| Last Update Date | 2017-01-27 |