| NPI | 1750763157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 079192) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC LL37853) |
| Enumeration Date | 2015-06-22 |
| Last Update Date | 2018-10-30 |