| NPI | 1912931783 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 8424) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 42510) |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2016-07-22 |