| NPI | 1427028323 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 31204) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: CA C51355) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME111896) | |
| Enumeration Date | 2006-01-24 |
| Last Update Date | 2012-01-24 |