| NPI | 1073673562 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 19591) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 5520) |
| 174400000X Specialist | |
| Enumeration Date | 2006-12-12 |
| Last Update Date | 2021-10-04 |