| NPI | 1386969111 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0056632) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 92404071205) |
| Enumeration Date | 2010-04-05 |
| Last Update Date | 2021-11-20 |