| NPI | 1174508592 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME54846) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 41944) |
| Enumeration Date | 2005-12-08 |
| Last Update Date | 2017-08-31 |