| NPI | 1265624035 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 7002998-1205) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: PA MD427727) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ID M-10415) | |
| Enumeration Date | 2007-08-15 |
| Last Update Date | 2012-08-30 |