| NPI | 1558367011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.11170R) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 00070R) |
| Enumeration Date | 2005-06-21 |
| Last Update Date | 2017-04-27 |