| NPI | 1235134438 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WY 5238A) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MT 6547) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: ID M-7672) | |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2019-05-23 |