| NPI | 1932104122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NC 24349) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 37265) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2017-12-20 |