| NPI | 1558386706 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 082121) |
| Additional Taxonomies | 174400000X Specialist (Licence: VA 0101042362) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: GA 82121) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2020-10-22 |