| NPI | 1487652707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: LA 11265R) |
| Additional Taxonomies | 174400000X Specialist (Licence: LA 11265R) |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2011-05-09 |