| NPI | 1285613091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MT 10839) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 31004) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 10010) | |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2014-09-12 |