| NPI | 1689609406 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 060001) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CT 019592) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-07-08 |