| NPI | 1225096563 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 30485) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 30485) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2016-11-04 |