| NPI | 1053367649 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M9586) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: ME 015871) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: OK 28201) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2012-04-12 |