| NPI | 1215949060 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0001X (Licence: MI 4301042934) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 042934) |
| 2085R0203X Radiology, Therapeutic Radiology (Licence: MI 4301042934) | |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2013-09-25 |