| NPI | 1326330143 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PR 022228) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101261907) |
| Enumeration Date | 2011-05-12 |
| Last Update Date | 2023-11-16 |