| NPI | 1104807825 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.019756) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 16309) |
| Enumeration Date | 2005-11-09 |
| Last Update Date | 2024-07-31 |