| NPI | 1255319331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: WI 51727) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 181786-1205) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA G86494) | |
| Enumeration Date | 2006-01-09 |
| Last Update Date | 2009-07-21 |