| NPI | 1124179403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: VA 0101020596) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D23126) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: DC MD32124) | |
| Enumeration Date | 2007-01-15 |
| Last Update Date | 2007-07-08 |