| NPI | 1235455056 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 38955) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MT186557) |
| Enumeration Date | 2010-04-19 |
| Last Update Date | 2021-04-27 |