| NPI | 1194926741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX N9299) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AL 00027147) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2010-00475) | |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2014-10-30 |