| NPI | 1609838028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200100627) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 22863) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2020-09-12 |