| NPI | 1750351359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: GA 025199) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: SC 15773) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2013-02-26 |