| NPI | 1891781886 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 25985) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: ND 4828) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2019-02-18 |