| NPI | 1447243878 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME111851) |
| Additional Taxonomies | 174400000X Specialist (Licence: MA 220245) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A95087) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2015-04-02 |