| NPI | 1548213812 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CA A74811) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: VT 042-0011269) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: NV 10202) | |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2019-04-18 |