| NPI | 1114956695 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 27454) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011504) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A78590) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2013-08-06 |