| NPI | 1770512477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 1278) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ID 0215) |
| Enumeration Date | 2006-07-03 |
| Last Update Date | 2015-11-19 |