| NPI | 1902882657 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 17087) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 017087) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2018-05-23 |