| NPI | 1174507750 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 16600) |
| Additional Taxonomies | 2085B0100X Radiology, Body Imaging (Licence: CO 16600) |
| 2085N0700X (Licence: CO 16600) | |
| 2085N0904X (Licence: CO 16600) | |
| 2085P0229X Radiology, Pediatric Radiology (Licence: CO 16600) | |
| Enumeration Date | 2005-12-06 |
| Last Update Date | 2013-10-01 |