| NPI | 1720020092 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 9242) |
| Additional Taxonomies | 174400000X Specialist (Licence: AL 9242) |
| Enumeration Date | 2006-06-12 |
| Last Update Date | 2012-07-09 |