| NPI | 1235379017 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 064300) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 239046) |
| Enumeration Date | 2009-03-06 |
| Last Update Date | 2021-06-17 |