| NPI | 1023055720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 51463) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 82118) |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2018-03-17 |