| NPI | 1790776748 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 43841) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 35986) |
| Enumeration Date | 2005-10-31 |
| Last Update Date | 2010-07-19 |