| NPI | 1568649168 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD449234) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 390200000x) |
| Enumeration Date | 2008-01-25 |
| Last Update Date | 2020-08-19 |