| NPI | 1356331136 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M4176) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: LA MD.025261) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: AR E4774) | |
| Enumeration Date | 2005-10-24 |
| Last Update Date | 2009-09-24 |