| NPI | 1780735845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q6818) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 263349) |
| Enumeration Date | 2007-01-16 |
| Last Update Date | 2016-05-18 |