| NPI | 1285607770 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2000-01076) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: SC 9301) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101036308) | |
| Enumeration Date | 2006-02-07 |
| Last Update Date | 2017-12-20 |