| NPI | 1386611556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 52201) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 21837) |
| Enumeration Date | 2006-03-07 |
| Last Update Date | 2018-05-14 |