| NPI | 1962660407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO DR.0053717) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX N4077) |
| Enumeration Date | 2008-05-31 |
| Last Update Date | 2017-01-04 |