| NPI | 1447461264 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 53812) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 9826A) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 27836) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2014-09-19 |