| NPI | 1033206735 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E-6433) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2007033983) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2004015397) | |
| Enumeration Date | 2006-10-06 |
| Last Update Date | 2012-04-20 |