| NPI | 1467620005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 13892) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: AZ 80991) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 53352) | |
| Enumeration Date | 2008-02-18 |
| Last Update Date | 2013-06-27 |