| NPI | 1215165147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 15776) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MA 258339) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 6031) | |
| Enumeration Date | 2009-06-30 |
| Last Update Date | 2016-07-27 |