| NPI | 1538116967 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 51985) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: UT 271018-1205) |
| Enumeration Date | 2006-05-30 |
| Last Update Date | 2014-12-18 |