| NPI | 1902851025 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 50059) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 249036) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A77289) | |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2018-01-15 |