| NPI | 1457513152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: FL ME115900) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IL 125-054017) |
| Enumeration Date | 2008-06-25 |
| Last Update Date | 2014-11-12 |