| NPI | 1700807104 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 5101010590) |
| Additional Taxonomies | 174400000X Specialist (Licence: MI 5101010590) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-07-21 |