| NPI | 1972552107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 066883) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 47555) |
| Enumeration Date | 2006-05-06 |
| Last Update Date | 2019-05-06 |