| NPI | 1780645028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21193) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 45475) |
| Enumeration Date | 2006-03-28 |
| Last Update Date | 2014-03-11 |