| NPI | 1194873463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 45315) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 32008) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A89659) | |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2017-01-03 |