| NPI | 1457551343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.202852) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS t1813) |
| Enumeration Date | 2007-07-19 |
| Last Update Date | 2017-08-15 |