| NPI | 1073544821 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: VA 0101239728) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 62732) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2021-04-06 |