| NPI | 1023088606 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101055481) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA 6414E) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: LA R2215) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2007-07-08 |