| NPI | 1497918270 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MO 2014000217) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2013-00659) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: KS 0437072) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2014-03-20 |