| NPI | 1417953795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 9828) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NH 14876) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0012096) | |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2019-05-14 |