| NPI | 1669503090 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 32154) |
| Additional Taxonomies | 174400000X Specialist (Licence: AZ 32154) |
| Enumeration Date | 2007-03-08 |
| Last Update Date | 2019-01-02 |