| NPI | 1033139050 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 058004) | 
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22335) | 
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23387) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 33206) | |
| Enumeration Date | 2006-07-20 | 
| Last Update Date | 2022-03-30 |