| NPI | 1982658381 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX Q2069) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 18255) |
| Enumeration Date | 2006-05-20 |
| Last Update Date | 2015-04-29 |