| NPI | 1033367065 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6351781-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301096633) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-11422) | |
| Enumeration Date | 2008-09-03 |
| Last Update Date | 2012-08-30 |