| NPI | 1639131162 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME35469) |
| Additional Taxonomies | 174400000X Specialist (Licence: FL ME35469) |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2015-09-25 |