| NPI | 1982943908 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2019-00420) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 3404) |
| Enumeration Date | 2013-02-11 |
| Last Update Date | 2019-08-27 |