| NPI | 1275780447 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 300913) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 6353) |
| Enumeration Date | 2008-08-19 |
| Last Update Date | 2017-03-01 |