| NPI | 1902821259 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M6387) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 051845) |
| Enumeration Date | 2006-07-13 |
| Last Update Date | 2020-05-19 |