| NPI | 1992745533 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 6047) |
| Additional Taxonomies | 174400000X Specialist (Licence: MN 33729) |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2018-03-16 |