| NPI | 1548222094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: GA 054057) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: NC 4021903) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: WV 01814) | |
| Enumeration Date | 2006-04-03 |
| Last Update Date | 2012-09-11 |