| NPI | 1265469399 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 36220) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 3921A) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2016-07-28 |