| NPI | 1972820942 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 247147) |
| Additional Taxonomies | 174400000X Specialist |
| Enumeration Date | 2010-04-29 |
| Last Update Date | 2021-01-19 |