| NPI | 1396736153 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC MD10497) |
| Additional Taxonomies | 174400000X Specialist (Licence: SC 10497) |
| Enumeration Date | 2005-11-02 |
| Last Update Date | 2021-10-12 |