| NPI | 1457367864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 32237) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 23434) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 5647A) | |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2008-11-07 |