| NPI | 1255327870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NH 11091) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MA 45342) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA G85543) | |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2016-04-13 |