| NPI | 1568663227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 2085R0202X Radiology Diagnostic Radiology (Licence: CO 47754) |
| Additional Taxonomies | 2085R0202X Radiology Diagnostic Radiology (Licence: MI 4301081484) |
| Enumeration Date | 2007-05-30 |
| Last Update Date | 2010-04-19 |