| NPI | 1730323213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 24063) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 25912) |
| Enumeration Date | 2009-04-28 |
| Last Update Date | 2019-07-18 |