| NPI | 1093785594 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 23272) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 42077-020) |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2014-05-06 |