| NPI | 1881012912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM A-2258-19) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AK 146771) |
| Enumeration Date | 2014-04-05 |
| Last Update Date | 2019-07-11 |