| NPI | 1699707398 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 39295) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101239404) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2008-01-02 |