| NPI | 1528058716 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CA G89410) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: TX E08276) |
| 2085R0202X Radiology Diagnostic Radiology (Licence: MN 25292) | |
| Enumeration Date | 2005-10-27 |
| Last Update Date | 2015-12-08 |