| NPI | 1417165465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 064432) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101240371) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A108438) | |
| Enumeration Date | 2007-05-21 |
| Last Update Date | 2020-06-04 |