| NPI | 1053366856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME104949) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 20214) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2018-08-14 |