| NPI | 1992786586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2015-00516) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 38611) |
| Enumeration Date | 2005-11-10 |
| Last Update Date | 2017-12-20 |