| NPI | 1508881764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO DR0048452) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NE 28294) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WY 9982A) | |
| Enumeration Date | 2006-07-12 |
| Last Update Date | 2015-09-16 |