| NPI | 1518158773 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: MS 21296) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A102115) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: TX M8517) | |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 2008-01950) | |
| Enumeration Date | 2007-08-05 |
| Last Update Date | 2012-05-09 |