| NPI | 1003985771 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301079774) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 12094) |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2019-09-20 |