| NPI | 1831366582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: RI 12926) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 235803) |
| Enumeration Date | 2008-05-13 |
| Last Update Date | 2019-03-11 |