| NPI | 1306055678 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: NE 29349) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA R-7426) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CO 47676) | |
| 2085R0202X Radiology Diagnostic Radiology (Licence: NC 2008-01132) | |
| Enumeration Date | 2007-05-22 |
| Last Update Date | 2016-07-03 |