| NPI | 1508032103 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: ND 12961) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 52223) |
| Enumeration Date | 2008-05-02 |
| Last Update Date | 2014-08-27 |