| NPI | 1265666762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 55651) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28707) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY TL3089) | |
| Enumeration Date | 2009-05-12 |
| Last Update Date | 2015-10-06 |