| NPI | 1548264286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: WI 17157) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: MN 16641) |
| 2085R0202X Radiology, Diagnostic Radiology (Licence: IA 26079) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2007-07-08 |