| NPI | 1265554570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 20797) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 20797) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2022-01-30 |