| NPI | 1639114838 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR.0037840) |
| Additional Taxonomies | 174400000X Specialist (Licence: CO 37840) |
| Enumeration Date | 2006-06-19 |
| Last Update Date | 2016-11-18 |