| NPI | 1255333555 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 30602) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 27412) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44784) | |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2015-09-22 |