| NPI | 1720081649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301097371) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 12562) |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2010-10-06 |