| NPI | 1164606604 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2014-00743) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A90306) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 37521) | |
| Enumeration Date | 2007-12-19 |
| Last Update Date | 2017-12-20 |