| NPI | 1285610923 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME94244) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 43039) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2013-10-22 |