| NPI | 1457449126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 50047) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 200601249) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: VA 0101247400) | |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2012-05-01 |