| NPI | 1811956303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 32826) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 42220) |
| Enumeration Date | 2006-03-22 |
| Last Update Date | 2019-10-28 |