| NPI | 1528092160 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 49616) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 39575) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 54278) | |
| Enumeration Date | 2006-07-10 |
| Last Update Date | 2014-04-21 |