| NPI | 1972860831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME134396) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 005920) |
| Enumeration Date | 2012-04-17 |
| Last Update Date | 2018-08-16 |