| NPI | 1215083498 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: FL ME111795) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2004010700) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 23847) | |
| Enumeration Date | 2007-01-28 |
| Last Update Date | 2012-04-25 |