| NPI | 1619032661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD435454) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR-48643) |
| Enumeration Date | 2006-12-27 |
| Last Update Date | 2021-06-25 |