| NPI | 1073841615 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OS015976) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA OT012102) |
| Enumeration Date | 2009-11-19 |
| Last Update Date | 2020-10-05 |