| NPI | 1487617403 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 24027) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2003-01250) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 37408) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2010-02-01 |