| NPI | 1942227913 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CT 046407) |
| Additional Taxonomies | 2085U0001X Radiology Diagnostic Ultrasound (Licence: MA 246268) |
| Enumeration Date | 2006-07-16 |
| Last Update Date | 2018-03-17 |