| NPI | 1508837832 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 13079) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA G51110) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX G9508) | |
| Enumeration Date | 2006-01-26 |
| Last Update Date | 2012-01-27 |