| NPI | 1275589012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 9700972) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: TN 30402) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101057637) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2016-04-01 |