| NPI | 1760440218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 23917) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200600094) |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2021-03-23 |