| NPI | 1528044393 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: NM 80-278) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 44127) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WA MD00047308) | |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2017-03-31 |