| NPI | 1477590966 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: AZ 4613) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: OK 3991) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: FL OS 9758) | |
| Enumeration Date | 2006-06-01 |
| Last Update Date | 2010-04-09 |