| NPI | 1851307359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301069519) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: MI 4301069519) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: FM 4301069519) | |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2019-06-28 |