| NPI | 1568666147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX BP2-0026329) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA 204649) |
| Enumeration Date | 2007-06-14 |
| Last Update Date | 2021-06-08 |