| NPI | 1225172661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-10706) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: PA MD430572) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: UT 7345497-1205) | |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2013-03-14 |