| NPI | 1760440507 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 21077) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 31581) |
| Enumeration Date | 2006-05-02 |
| Last Update Date | 2021-11-16 |