| NPI | 1114907425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 60509) |
| Additional Taxonomies | 174400000X Specialist (Licence: MO 105282) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2024-03-31 |