| NPI | 1376659953 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME128777) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 48620) |
| Enumeration Date | 2006-08-23 |
| Last Update Date | 2017-08-11 |