| NPI | 1285630277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 31146) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 33698) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 27627) | |
| Enumeration Date | 2005-06-23 |
| Last Update Date | 2013-12-19 |