| NPI | 1306868294 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 54149-20) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MD D63756) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301097732) | |
| Enumeration Date | 2006-07-23 |
| Last Update Date | 2011-06-29 |