| NPI | 1053511469 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 51719) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OR MD27003) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NE 26981) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: WY 9127A) | |
| Enumeration Date | 2007-07-23 |
| Last Update Date | 2015-09-16 |