| NPI | 1154465482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: OR MD08996) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00034639) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 30952) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2007-07-08 |