| NPI | 1407821424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME61941) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME61941) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2021-08-03 |