| NPI | 1952483554 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 01527) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: KY 02737) |
| Enumeration Date | 2006-10-20 |
| Last Update Date | 2016-04-27 |