| NPI | 1184657579 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 22550) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 20531) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 7648A) | |
| Enumeration Date | 2006-07-08 |
| Last Update Date | 2018-04-11 |