| NPI | 1942255062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 054570) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL 4570) |
| Enumeration Date | 2006-05-24 |
| Last Update Date | 2011-05-24 |