| NPI | 1194979856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NV 16140) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 45665) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA A112768) | |
| Enumeration Date | 2008-11-07 |
| Last Update Date | 2015-11-20 |