| NPI | 1770530909 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301503245) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 40564) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2020-12-07 |