| NPI | 1114906054 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 7205) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G76499) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 24927) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2011-10-29 |