| NPI | 1356327472 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 47412) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 43182) |
| Enumeration Date | 2005-12-20 |
| Last Update Date | 2020-09-08 |