| NPI | 1386840742 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 52665) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 68620) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2008011534) | |
| Enumeration Date | 2007-06-22 |
| Last Update Date | 2014-09-26 |