| NPI | 1386647063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME55202) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 36506) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: AR E-4126) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2016-12-08 |