| NPI | 1851612782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 12715) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 54206) |
| Enumeration Date | 2010-06-15 |
| Last Update Date | 2020-09-21 |