| NPI | 1396953444 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 63899) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101239687) |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2021-06-21 |