| NPI | 1093910457 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 053802) |
| Additional Taxonomies | 174400000X Specialist (Licence: GA 053802) |
| Enumeration Date | 2007-06-18 |
| Last Update Date | 2017-06-29 |