| NPI | 1043213895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 24982) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 26251) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44358) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2015-09-30 |