| NPI | 1366641383 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 57090) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 37348) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 55057) | |
| Enumeration Date | 2007-07-11 |
| Last Update Date | 2015-09-24 |