| NPI | 1326083361 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 4525A) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 29468) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 21266) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2015-03-18 |