| NPI | 1497976047 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MI 4301083627) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 104391) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52158) | |
| Enumeration Date | 2007-05-01 |
| Last Update Date | 2013-04-16 |