| NPI | 1558533356 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology, Diagnostic Radiology (Licence: CO 47783) |
| Additional Taxonomies | 2085R0202X Radiology, Diagnostic Radiology (Licence: UT 6918010-1205) |
| Enumeration Date | 2008-04-01 |
| Last Update Date | 2011-02-04 |