| NPI | 1083619456 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 056029) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 056029) |
| Enumeration Date | 2005-06-14 |
| Last Update Date | 2022-03-03 |