| NPI | 1003822115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101249042) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 242982) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2022-11-29 |