| NPI | 1023092095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 96-01000) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 27821) |
| Enumeration Date | 2005-12-02 |
| Last Update Date | 2020-09-13 |