| NPI | 1093743338 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0038816) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 38816) |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2016-11-18 |