| NPI | 1528078110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: MN 27174) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: IA 22238) |
| Enumeration Date | 2006-08-08 |
| Last Update Date | 2013-02-21 |