| NPI | 1306832332 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 41037) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MD D0053786) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: CA G88087) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2011-05-23 |