| NPI | 1871554303 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 51520) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 226793) |
| Enumeration Date | 2006-04-02 |
| Last Update Date | 2014-09-26 |