| NPI | 1033111091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 18098) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44477) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 26185) | |
| Enumeration Date | 2005-06-02 |
| Last Update Date | 2007-07-08 |