| NPI | 1497042733 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR DO176358) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101019457) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0058751) | |
| Enumeration Date | 2011-07-07 |
| Last Update Date | 2020-12-15 |