| NPI | 1831449487 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX R7760) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 7009) |
| Enumeration Date | 2012-09-11 |
| Last Update Date | 2018-08-10 |